A trial can be positive for one outcome and neutral for another, and both can be true at once. Before applying a result, match its outcome to the decision in front of you.
In older adults, prevention decisions often turn on what the patient values: avoiding an event, living longer, or staying independent. A drug can reduce events without changing independence, and a screening test can find more disease without changing the stage at which it is found.
Ask the patient what they want to protect, then look for the outcome that measures it.
- Separate outcomes that clinicians count, such as events, from outcomes that patients feel, such as function.
- Check whether the trial population resembles the patient in front of you in age, comorbidity and baseline risk.
- Look at absolute differences per 1000 person-years or per 100 patients to explain benefit.
- Record the patient's priorities before discussing preventive treatment.
Why it matters
Different outcomes in the same trial can point towards opposite decisions.
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